About Multiple Myeloma

What is Multiple Myeloma
Risk Factors
Symptoms

Screening and Diagnosis
Staging
Common Treatment Options

What is Multiple Myeloma?
Multiple myeloma is a complex cancer of bone marrow plasma cells, a type of white blood cell that produces antibodies called immunoglobulins and plays a critical role in the immune system. Normally, they make up a very small portion (less than 5 percent) of the cells in the bone marrow, the soft material in the center of most bones. In people with multiple myeloma, more than 10 percent and sometimes higher than 90 percent of the cells in their bone marrow are plasma cells. This is because the abnormal cells divide again and again, making more and more abnormal cells.

These abnormal plasma cells build up in the bone marrow and crowd out normal cells. Though multiple myeloma affects the bone, it is considered a hematologic (blood-based) malignancy because the cancerous cells are plasma cells, not bone cells.

Risk Factors
There is no known cause of multiple myeloma. However, research has shown that people with certain risk factors are more likely than others to develop the disease. Risk factors for multiple myeloma include:

Age and Gender: Growing older increases the chance of developing multiple myeloma. The average age when myeloma is diagnosed is 71. This disease is not normally found in people younger than 40. Men are slightly more likely to develop multiple myeloma than women.
Race: The risk of developing multiple myeloma is highest among African Americans and lowest among Asian Americans. The reason for this difference is not known.
Other Plasma Cell Disorders: MGUS and solitary plasmacytomas are disorders that can lead to multiple myeloma and are therefore considered risk factors.

Symptoms
In the early stages of multiple myeloma there may not be any symptoms. One or more of the following symptoms may occur as the disease progresses:

Bone pain: Bone is formed by cells called osteoblasts and dissolved by cells called osteoclasts. Myeloma cells can release substances that activate the bone-dissolving osteoclasts, and block the bone-producing osteoblasts. This can cause bone weakness, pain, fractures and even breaks. Any bone might be affected, but pain in the spine and pelvis is usually the most common.
Anemia: The myeloma cells can release a hormone that inhibits red blood cell growth. A reduced amount of red blood cells leads to anemia, which causes weakness, decreased ability to exercise, shortness of breath and dizziness. Over two thirds of patients have anemia when they have multiple myeloma.
Nervous system symptoms: Collapsed spinal bones can compress important nerves, causing severe pain, numbness, and/or muscle weakness. In addition, myeloma proteins can also affect the nerves.
Kidney damage: Abnormal amounts of myeloma protein can damage the kidneys. This reduces a person's ability to process excess salt, fluid and body waste products.
High blood calcium: Sometimes myeloma causes bones to dissolve so quickly that large amounts of calcium are released into the blood. This can cause kidneys to fail. Symptoms resulting from too much calcium in the blood include thirst, dry mouth, loss of appetite, drowsiness, constipation, nausea, vomiting and confusion.
Infections: People with myeloma are much more likely to develop infections, pneumonia being most common. This happens because the body is unable to make the antibodies that help fight the infection. Multiple myeloma patients are also more prone to get shingles.

Screening and Diagnosis
When multiple myeloma is suspected, the following tests and exams may be ordered:

Blood tests: Blood tests are necessary to measure blood counts, calcium level, kidney function, myeloma proteins and evaluate for anemia.
Urine tests: The laboratory checks the urine for abnormal proteins including a type of myeloma protein called Bence-Jones.
Bone surveys: Radiologists take X-rays to detect weakened and fractured bones. A more in-depth imaging study using advanced scanning technology (CT scan, MRI, PET scan) can often detect tumor masses and the presence of myeloma that X-rays may not reveal.
Bone marrow biopsy: In a bone marrow biopsy, the physician removes tissue to check for cancer cells. It is the only way to know with certainty whether myeloma cells are in the bone marrow. The bone marrow is removed from a large bone in the pelvis. Local anesthesia is used to help reduce the discomfort.
There are two parts to a bone marrow examination:
1. Aspiration: A thin needle removes a small sample of bone marrow tissue.
2. Biopsy: A thick needle removes a small piece of bone.
Once the biopsy is completed, a pathologist uses a microscope to check the tissue for cancer and myeloma cells and runs special tests.

Staging
If a biopsy reveals that you have multiple myeloma, your physician needs to determine the extent (stage) of the disease to create the best treatment plan and provide an accurate prognosis.

Common Treatment Options
The treatment of myeloma and other hematologic malignancies is based on determining the correct diagnosis and staging of the disease. Treatment is given to control the myeloma and improve quality and duration of life. Treatment may also control the effects of the disease or halt it temporarily. Remissions can last for years. Depending on the stage, the most common forms of treatment are chemotherapy and/or blood stem cell transplantation.